Get Form Lic446-4a - California Department Of Insurance - State Of ...

This guide provides a step-by-step approach to filling out the Form LIC446-4A, which is essential for California providers to submit their list of instructors and subject matter experts. Follow these instructions to efficiently complete the form online.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in a suitable editor.
2. Begin by entering the provider name in the designated field at the top of the form.
3. Next, input the provider number which uniquely identifies your organization.
4. Include the provider director's name in the appropriate section, ensuring all details are correct.
5. Have the provider director sign the form in the signature field provided.
6. Date the signature to confirm when the form was completed.
7. List the full name of each instructor or subject matter expert in the designated spaces, ensuring to include middle names where applicable.
8. Input the California Insurance License Number for each individual, or their Social Security Number if no license number is available.
9. If applicable, check the SSN Exempt box to indicate that the individual will be utilized for a one-time continuing education event only.
10. If more space is needed, attach additional sheets as specified, and ensure all attached information is clearly labeled.
11. Once all required fields are completed, review your entries for accuracy, save the changes, and download the form, if necessary. You may also print or share the completed form as required.

Complete your documentation needs online by filling out the form now.